Case Report
Primary Seminal Vesicle Carcinoma
Detected at Transurethral Resection
of Prostate
Lars Egevad, Roy Ehrnström, Ulf Håkansson, and Magnus Grabe
We present a case of primary seminal vesicle carcinoma detected at transurethral resection. The clinical presentation,
radiologic findings, and pathologic features of these tumors are reviewed. Grossly, seminal vesicle carcinoma is poorly
circumscribed and solid or solid/cystic and may be misinterpreted as an abscess or hemorrhage on radiologic
examination. Although a definitive diagnosis often cannot be given until after complete resection, we describe the
findings indicative of seminal vesicle origin, including papillary histologic architecture, sometimes with mucinous
differentiation, and a characteristic immunophenotype positive for CA-125 and cytokeratin 7, but negative for
prostate-specific antigen and cytokeratin 20.
UROLOGY
69: 778.e11–778.e13, 2007. © 2007 Elsevier Inc.
P
rimary seminal vesicle carcinoma (SVC) is a very rare
tumor, and only 51 well-documented cases have been
reported.
1
The diagnosis is generally based on a com-
bination of morphologic, immunohistochemical, and clini-
cal findings, including radiologic examination. It is difficult
to make a definitive diagnosis using biopsy, and surgical
resection is usually required to determine whether the epi-
center is in the seminal vesicles and whether it is primary to
this site. We present a case of primary SVC suspected at
transurethral resection of the prostate (TURP) and subse-
quently verified after procto-cysto-prostatectomy.
CASE REPORT
A 73-year-old man with hematuria and hematospermia was
first examined in March 2004. Digital rectal examination
showed an enlarged multilobular right seminal vesicle that
was confirmed by ultrasonography. The prostate volume was
estimated at 85 cm
3
. The cystoscopy findings and serum
prostate-specific antigen (PSA) level were normal (1.7 ng/
mL). Urinary cytology showed dissociated high-grade ma-
lignant cells with pleomorphic nuclei and no signs of ade-
nocarcinoma differentiation. Computed tomography (CT)
scan showed a multilobular, 12-cm-diameter, low-attenu-
ated expansile process close to the prostate and on the site
of the right seminal vesicle (Fig. 1). A diagnosis of abscess or
hemorrhage was considered because of the partially cystic
appearance. The patient underwent chest x-ray and CT of
chest and abdomen without signs of malignancy elsewhere.
He denied previous cancer, and his pathology record did not
contain any malignant diagnoses. Because the patient had
hematospermia and lower urinary tract symptoms indicating
bladder outlet obstruction, as well as a normal serum PSA
value, we decided to perform diagnostic TURP with no
preceding transrectal biopsy. This was done in February
2005, and adenocarcinoma was found on histologic exam-
ination. The tumor had columnar-stratified epithelium with
elongated nuclei and a predominantly papillary architecture
similar to ductal carcinoma of the prostate. However, im-
munostains for PSA and prostate-specific acid phosphatase
(PSAP) were negative. Furthermore, cytokeratin (CK) 7
and CK20 were negative, and p53, carcinoembryonic anti-
gen, and CA-125 were positive. High-molecular-weight CK
was diffusely positive without a basal cell pattern. In view of
the clinical and radiologic findings, a diagnosis of primary
SVC was suggested. Another CT scan showed that the
From the International Agency for Research on Cancer, Lyon, France; and Depart-
ments of Urology
AND
Pathology, Malmö University Hospital, Malmö, Sweden
Address for correspondence: Lars Egevad, M.D., Ph.D., Pathology Group, Inter-
national Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, Lyon
69372 Cedex 08, France. E-mail: EGEVADL@iarc.fr
Submitted: September 15, 2006; accepted (with revisions): December 7, 2007
Figure 1. Front view of CT scan showing multilobular, low-
attenuated, expansile process close to prostate and on site
of right seminal vesicle (asterisk). Urinary bladder was
dislocated.
© 2007 Elsevier Inc. 0090-4295/07/$32.00 778.e11
All Rights Reserved doi:10.1016/j.urology.2007.02.011